Data Exchange For Quality Measures Implementation Guide
1.0.0-ballot - STU 1 Ballot International flag

Data Exchange For Quality Measures Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-deqm/ and changes regularly. See the Directory of published versions

Resource Profile: DEQM Data Exchange MeasureReport Profile - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 4

Definitions for the deqm-dataexchangemeasurereport resource profile

Guidance on how to interpret the contents of this table can be foundhere

0. MeasureReport
Definition

The MeasureReport resource contains the results of the calculation of a measure; and optionally a reference to the resources involved in that calculation.

ShortResults of a measure evaluation
Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information ((type != 'data-collection') or group.exists().not())
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components (group.stratifier.stratum.all(value.exists() xor component.exists()))
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information ((type != 'data-collection') or group.exists().not())
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components (group.stratifier.stratum.all(value.exists() xor component.exists()))
2. MeasureReport.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. MeasureReport.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control10..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on MeasureReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. MeasureReport.extension:updatetype
    Slice Nameupdatetype
    Definition

    Optional Extension Element - found in all resources.

    ShortOptional Extensions Element
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(DEQM Submit Data Update Type Extension) (Extension Type: code)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. MeasureReport.extension:measurereport-category
    Slice Namemeasurereport-category
    Definition

    Specifies the category of a measure report.

    ShortWhat category is this measure report
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Measure Report Category) (Extension Type: CodeableConcept)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. MeasureReport.extension:software
    Slice Namesoftware
    Definition

    Specifies the software systems used in the packaging and testing of knowledge artifacts. Specifically to support explicitly stating which versions of the various software components were used in the authoring, packaging, and testing.

    ShortExtension
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(CRMI Software System) (Extension Type: Reference(CRMI Software System Device))
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. MeasureReport.extension:vendor
    Slice Namevendor
    Definition

    A reference to the vendor who queried the data, calculated results and/or generated the report.

    ShortVendor information
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(DEQM Reporting Vendor Extension) (Extension Type: Reference(Organization))
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. MeasureReport.extension:location
    Slice Namelocation
    Definition

    Location from which reported data was gathered. This extension is used to provide the location(s) from which reported data was gathered in a MeasureReport, such as individual, summary and data exchange measure report.

    ShortLocation(s) from which reported data was gathered
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(DEQM Data Location Extension) (Extension Type: Reference(Location))
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. MeasureReport.extension:message
    Slice Namemessage
    Definition

    An OperationOutcome resource with information, warning, or error messages that were generated as part of processing an operation.

    ShortMessages encountered while creating the report
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Messages) (Extension Type: Reference(OperationOutcome))
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. MeasureReport.extension:inputParameters
    Slice NameinputParameters
    Definition

    Specifies the input parameters to the operation (such as a test case description or a data requirements or evaluate operation). This extension can be used as part of the result of an operation to indicate what the parameters were, but it can also be used as part of the definition of a test case to specify what the input parameters are expected to be for the test case.

    ShortWhat parameters
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Input parameters) (Extension Type: Reference(Parameters))
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    20. MeasureReport.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    22. MeasureReport.status
    Definition

    The MeasureReport status. No data will be available until the MeasureReport status is complete.

    Shortcomplete | pending | error
    Comments

    This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/measure-report-status)
    Typecode
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. MeasureReport.type
    Definition

    The type of measure report. This may be an individual report, which provides the score for the measure for an individual member of the population; a subject-listing, which returns the list of members that meet the various criteria in the measure; a summary report, which returns a population count for each of the criteria in the measure; or a data-collection, which enables the MeasureReport to be used to exchange the data-of-interest for a quality measure.

    Shortindividual | subject-list | summary | data-collection
    Comments

    Data-collection reports are used only to communicate data-of-interest for a measure. They do not necessarily include all the data for a particular subject or population, but they may.

    Control1..1
    This element is affected by the following invariants: mrp-1
    BindingThe codes SHALL be taken from MeasureReportTypehttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
    (required to http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1)

    The type of the measure report.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Fixed Valuedata-collection
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. MeasureReport.measure
    Definition

    A reference to the Measure that was calculated to produce this report. When known, the version of the measure SHALL be included.


    A reference to the Measure that was calculated to produce this report.

    ShortWhat measure and version was calculatedWhat measure was calculated
    Control1..1
    Typecanonical(Measure)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    This will indicate the measure being reported on. For example, the cannonical uri location for the MRP measure.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. MeasureReport.subject
    Definition

    Optional subject identifying the individual or individuals the report is for.

    ShortWhat individual(s) the report is for
    Control10..1
    TypeReference(Patient, Practitioner, PractitionerRole, Location, Device, RelatedPerson, Group, Patient, Practitioner, PractitionerRole, Location, Device, RelatedPerson, Group)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. MeasureReport.date
    Definition

    The date this measure report was generated.

    ShortWhen the report was generated
    Control10..1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. MeasureReport.reporter
    Definition

    Who is reporting the data. The reporter is the entity fulfilling the reporting requirement.


    The individual, location, or organization that is reporting the data.

    ShortWho is reporting the data. The reporter is the entity fulfilling the reporting requirement.
    Control10..1
    TypeReference(Organization, Practitioner, PractitionerRole, Practitioner, PractitionerRole, Location, Organization)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. MeasureReport.period
    Definition

    The reporting period for which the report was calculated.

    ShortWhat period the report covers
    Control1..1
    This element is affected by the following invariants: deqm-1
    TypePeriod
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    deqm-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) (start.toString().length()>9 and end.toString().length()>9)
    36. MeasureReport.period.start
    Definition

    The start of the period. The boundary is inclusive.

    ShortStarting time with inclusive boundary
    Comments

    If the low element is missing, the meaning is that the low boundary is not known.

    Control10..1
    This element is affected by the following invariants: per-1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    38. MeasureReport.period.end
    Definition

    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

    ShortEnd time with inclusive boundary, if not ongoing
    Comments

    The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

    Control10..1
    This element is affected by the following invariants: per-1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    40. MeasureReport.improvementNotation
    Definition

    Whether improvement in the measure is noted by an increase or decrease in the measure score.

    Shortincrease | decrease
    Comments

    This element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score.

    Control0..1
    BindingThe codes SHALL be taken from MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
    (required to http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1)

    Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

    TypeCodeableConcept
    Is Modifiertrue because Improvement notation determines how to interpret the measure score (i.e. whether an increase is an improvement)
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    42. MeasureReport.group
    Definition

    The results of the calculation, one for each population group in the measure.

    ShortMeasure results for each group
    Control0..*
    This element is affected by the following invariants: mrp-1
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. MeasureReport.group.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control10..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on MeasureReport.group.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 46. MeasureReport.group.extension:linkId
      Slice NamelinkId
      Definition

      Optional Extension Element - found in all resources.

      ShortUnique id of the group from the measure.
      Control1..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension Definition for MeasureReport.group.linkId for Version 5.0) (Extension Type: string)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      48. MeasureReport.group.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      50. MeasureReport.group.population
      Definition

      The populations that make up the population group, one for each type of population appropriate for the measure.

      ShortThe populations in the group
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. MeasureReport.group.population.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control10..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on MeasureReport.group.population.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 54. MeasureReport.group.population.extension:linkId
        Slice NamelinkId
        Definition

        Optional Extension Element - found in all resources.

        ShortUnique id for group.population from the measure.
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Extension Definition for MeasureReport.group.population.linkId for Version 5.0) (Extension Type: string)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        56. MeasureReport.group.population.extension:description
        Slice Namedescription
        Definition

        A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

        ShortDescription of the population
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Measure Report Population Description) (Extension Type: markdown)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        58. MeasureReport.group.population.extension:supportingEvidence
        Slice NamesupportingEvidence
        Definition

        Specifies the result of a supporting evidence expression in the measure population. The result of the expression is represented in an extension, using the same mapping as specified in Using CQL With FHIR, with the exception that tuples and lists are represented in extensions, rather than mapped to the Parameters resource.

        ShortSpecifies the result of a supporting evidence expression in the measure population.
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Supporting Evidence) (Complex Extension)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        60. MeasureReport.group.population.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        62. MeasureReport.group.measureScore
        Definition

        The measure score for this population group, calculated as appropriate for the measure type and scoring method, and based on the contents of the populations defined in the group.

        ShortWhat score this group achieved
        Control0..01
        TypeQuantity
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        64. MeasureReport.group.stratifier
        Definition

        When a measure includes multiple stratifiers, there will be a stratifier group for each stratifier defined by the measure.

        ShortStratification results
        Control0..0*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        67. MeasureReport.evaluatedResource
        Definition

        A reference to a Bundle containing the Resources that were used in the calculation of this measure.

        ShortWhat data was used to calculate the measure score
        Control0..*
        TypeReference(Resource)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

        Guidance on how to interpret the contents of this table can be foundhere

        0. MeasureReport
        Must Supportfalse
        2. MeasureReport.extension:updatetype
        Slice Nameupdatetype
        Control1..1
        TypeExtension(DEQM Submit Data Update Type Extension) (Extension Type: code)
        Must Supporttrue
        4. MeasureReport.extension:measurereport-category
        Slice Namemeasurereport-category
        Control0..1
        TypeExtension(Measure Report Category) (Extension Type: CodeableConcept)
        Must Supporttrue
        6. MeasureReport.extension:software
        Slice Namesoftware
        Control0..*
        TypeExtension(CRMI Software System) (Extension Type: Reference(CRMI Software System Device))
        8. MeasureReport.extension:vendor
        Slice Namevendor
        Control0..1
        TypeExtension(DEQM Reporting Vendor Extension) (Extension Type: Reference(Organization))
        10. MeasureReport.extension:location
        Slice Namelocation
        Control0..*
        TypeExtension(DEQM Data Location Extension) (Extension Type: Reference(Location))
        12. MeasureReport.extension:message
        Slice Namemessage
        ShortMessages encountered while creating the report
        Control0..1
        TypeExtension(Messages) (Extension Type: Reference(OperationOutcome))
        14. MeasureReport.extension:inputParameters
        Slice NameinputParameters
        Control0..1
        TypeExtension(Input parameters) (Extension Type: Reference(Parameters))
        16. MeasureReport.status
        BindingThe codes SHALL be taken from MeasureReportStatus
        (required to http://hl7.org/fhir/ValueSet/measure-report-status)
        Must Supporttrue
        18. MeasureReport.type
        Typecode
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Fixed Valuedata-collection
        20. MeasureReport.measure
        Definition

        A reference to the Measure that was calculated to produce this report. When known, the version of the measure SHALL be included.

        ShortWhat measure and version was calculated
        Must Supporttrue
        Requirements

        This will indicate the measure being reported on. For example, the cannonical uri location for the MRP measure.

        22. MeasureReport.subject
        Control1..1
        TypeReference(Patient, Practitioner, PractitionerRole, Location, Device, RelatedPerson, Group)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        24. MeasureReport.date
        Control1..1
        Must Supporttrue
        26. MeasureReport.reporter
        Definition

        Who is reporting the data. The reporter is the entity fulfilling the reporting requirement.

        ShortWho is reporting the data. The reporter is the entity fulfilling the reporting requirement.
        Control1..1
        TypeReference(Organization, Practitioner, PractitionerRole)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        28. MeasureReport.period
        Control1..1
        This element is affected by the following invariants: deqm-1
        TypePeriod
        Must Supporttrue
        Invariantsdeqm-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) (start.toString().length()>9 and end.toString().length()>9)
        30. MeasureReport.period.start
        Control1..1
        Must Supporttrue
        32. MeasureReport.period.end
        Control1..1
        Must Supporttrue
        34. MeasureReport.group
        36. MeasureReport.group.extension:linkId
        Slice NamelinkId
        ShortUnique id of the group from the measure.
        Control1..1
        TypeExtension(Extension Definition for MeasureReport.group.linkId for Version 5.0) (Extension Type: string)
        Must Supporttrue
        38. MeasureReport.group.population
        40. MeasureReport.group.population.extension:linkId
        Slice NamelinkId
        ShortUnique id for group.population from the measure.
        Control1..1
        TypeExtension(Extension Definition for MeasureReport.group.population.linkId for Version 5.0) (Extension Type: string)
        Must Supporttrue
        42. MeasureReport.group.population.extension:description
        Slice Namedescription
        ShortDescription of the population
        Control0..1
        TypeExtension(Measure Report Population Description) (Extension Type: markdown)
        Must Supporttrue
        44. MeasureReport.group.population.extension:supportingEvidence
        Slice NamesupportingEvidence
        ShortSpecifies the result of a supporting evidence expression in the measure population.
        Control0..*
        TypeExtension(Supporting Evidence) (Complex Extension)
        Must Supporttrue
        46. MeasureReport.group.measureScore
        Control0..0
        48. MeasureReport.group.stratifier
        Control0..0
        50. MeasureReport.evaluatedResource
        Must Supporttrue

        Guidance on how to interpret the contents of this table can be foundhere

        0. MeasureReport
        Definition

        The MeasureReport resource contains the results of the calculation of a measure; and optionally a reference to the resources involved in that calculation.

        ShortResults of a measure evaluation
        Control0..*
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
        dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
        dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information ((type != 'data-collection') or group.exists().not())
        mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components (group.stratifier.stratum.all(value.exists() xor component.exists()))
        2. MeasureReport.id
        Definition

        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

        ShortLogical id of this artifact
        Comments

        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

        Control0..1
        Typeid
        Is Modifierfalse
        Summarytrue
        4. MeasureReport.meta
        Definition

        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

        ShortMetadata about the resource
        Control0..1
        TypeMeta
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. MeasureReport.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        8. MeasureReport.language
        Definition

        The base language in which the resource is written.

        ShortLanguage of the resource content
        Comments

        Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

        Control0..1
        BindingThe codes SHOULD be taken from CommonLanguages
        (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

        A human language.

        Additional BindingsPurpose
        AllLanguagesMax Binding
        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. MeasureReport.text
        Definition

        A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

        ShortText summary of the resource, for human interpretation
        Comments

        Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

        Control0..1
        TypeNarrative
        Is Modifierfalse
        Summaryfalse
        Alternate Namesnarrative, html, xhtml, display
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. MeasureReport.contained
        Definition

        These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

        ShortContained, inline Resources
        Comments

        This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

        Control0..*
        TypeResource
        Is Modifierfalse
        Summaryfalse
        Alternate Namesinline resources, anonymous resources, contained resources
        14. MeasureReport.extension
        Definition

        An Extension

        ShortExtension
        Control1..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on MeasureReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 16. MeasureReport.extension:updatetype
          Slice Nameupdatetype
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Control1..1
          This element is affected by the following invariants: ele-1
          TypeExtension(DEQM Submit Data Update Type Extension) (Extension Type: code)
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          18. MeasureReport.extension:measurereport-category
          Slice Namemeasurereport-category
          Definition

          Specifies the category of a measure report.

          ShortWhat category is this measure report
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Measure Report Category) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          20. MeasureReport.extension:software
          Slice Namesoftware
          Definition

          Specifies the software systems used in the packaging and testing of knowledge artifacts. Specifically to support explicitly stating which versions of the various software components were used in the authoring, packaging, and testing.

          ShortExtension
          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension(CRMI Software System) (Extension Type: Reference(CRMI Software System Device))
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          22. MeasureReport.extension:vendor
          Slice Namevendor
          Definition

          A reference to the vendor who queried the data, calculated results and/or generated the report.

          ShortVendor information
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(DEQM Reporting Vendor Extension) (Extension Type: Reference(Organization))
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          24. MeasureReport.extension:location
          Slice Namelocation
          Definition

          Location from which reported data was gathered. This extension is used to provide the location(s) from which reported data was gathered in a MeasureReport, such as individual, summary and data exchange measure report.

          ShortLocation(s) from which reported data was gathered
          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension(DEQM Data Location Extension) (Extension Type: Reference(Location))
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          26. MeasureReport.extension:message
          Slice Namemessage
          Definition

          An OperationOutcome resource with information, warning, or error messages that were generated as part of processing an operation.

          ShortMessages encountered while creating the report
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Messages) (Extension Type: Reference(OperationOutcome))
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          28. MeasureReport.extension:inputParameters
          Slice NameinputParameters
          Definition

          Specifies the input parameters to the operation (such as a test case description or a data requirements or evaluate operation). This extension can be used as part of the result of an operation to indicate what the parameters were, but it can also be used as part of the definition of a test case to specify what the input parameters are expected to be for the test case.

          ShortWhat parameters
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Input parameters) (Extension Type: Reference(Parameters))
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          30. MeasureReport.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summaryfalse
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          32. MeasureReport.identifier
          Definition

          A formal identifier that is used to identify this MeasureReport when it is represented in other formats or referenced in a specification, model, design or an instance.

          ShortAdditional identifier for the MeasureReport
          Comments

          Typically, this is used for identifiers that can go in an HL7 V3 II data type - e.g. to identify this {{title}} outside of FHIR, where the logical URL is not possible to use.

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows externally provided and/or usable business identifiers to be easily associated with the module.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          34. MeasureReport.status
          Definition

          The MeasureReport status. No data will be available until the MeasureReport status is complete.

          Shortcomplete | pending | error
          Comments

          This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

          Control1..1
          BindingThe codes SHALL be taken from MeasureReportStatus
          (required to http://hl7.org/fhir/ValueSet/measure-report-status)
          Typecode
          Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          36. MeasureReport.type
          Definition

          The type of measure report. This may be an individual report, which provides the score for the measure for an individual member of the population; a subject-listing, which returns the list of members that meet the various criteria in the measure; a summary report, which returns a population count for each of the criteria in the measure; or a data-collection, which enables the MeasureReport to be used to exchange the data-of-interest for a quality measure.

          Shortindividual | subject-list | summary | data-collection
          Comments

          Data-collection reports are used only to communicate data-of-interest for a measure. They do not necessarily include all the data for a particular subject or population, but they may.

          Control1..1
          This element is affected by the following invariants: mrp-1
          BindingThe codes SHALL be taken from MeasureReportType
          (required to http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1)

          The type of the measure report.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Fixed Valuedata-collection
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. MeasureReport.measure
          Definition

          A reference to the Measure that was calculated to produce this report. When known, the version of the measure SHALL be included.

          ShortWhat measure and version was calculated
          Control1..1
          Typecanonical(Measure)
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          This will indicate the measure being reported on. For example, the cannonical uri location for the MRP measure.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. MeasureReport.subject
          Definition

          Optional subject identifying the individual or individuals the report is for.

          ShortWhat individual(s) the report is for
          Control1..1
          TypeReference(Patient, Practitioner, PractitionerRole, Location, Device, RelatedPerson, Group)
          Is Modifierfalse
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          42. MeasureReport.date
          Definition

          The date this measure report was generated.

          ShortWhen the report was generated
          Control1..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. MeasureReport.reporter
          Definition

          Who is reporting the data. The reporter is the entity fulfilling the reporting requirement.

          ShortWho is reporting the data. The reporter is the entity fulfilling the reporting requirement.
          Control1..1
          TypeReference(Organization, Practitioner, PractitionerRole)
          Is Modifierfalse
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. MeasureReport.period
          Definition

          The reporting period for which the report was calculated.

          ShortWhat period the report covers
          Control1..1
          This element is affected by the following invariants: deqm-1
          TypePeriod
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          deqm-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) (start.toString().length()>9 and end.toString().length()>9)
          48. MeasureReport.period.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          50. MeasureReport.period.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on MeasureReport.period.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 52. MeasureReport.period.start
            Definition

            The start of the period. The boundary is inclusive.

            ShortStarting time with inclusive boundary
            Comments

            If the low element is missing, the meaning is that the low boundary is not known.

            Control1..1
            This element is affected by the following invariants: per-1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. MeasureReport.period.end
            Definition

            The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

            ShortEnd time with inclusive boundary, if not ongoing
            Comments

            The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

            Control1..1
            This element is affected by the following invariants: per-1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. MeasureReport.improvementNotation
            Definition

            Whether improvement in the measure is noted by an increase or decrease in the measure score.

            Shortincrease | decrease
            Comments

            This element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score.

            Control0..1
            BindingThe codes SHALL be taken from MeasureImprovementNotation
            (required to http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1)

            Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

            TypeCodeableConcept
            Is Modifiertrue because Improvement notation determines how to interpret the measure score (i.e. whether an increase is an improvement)
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. MeasureReport.group
            Definition

            The results of the calculation, one for each population group in the measure.

            ShortMeasure results for each group
            Control0..*
            This element is affected by the following invariants: mrp-1
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. MeasureReport.group.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            62. MeasureReport.group.extension
            Definition

            An Extension

            ShortExtension
            Control1..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on MeasureReport.group.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 64. MeasureReport.group.extension:linkId
              Slice NamelinkId
              Definition

              Optional Extension Element - found in all resources.

              ShortUnique id of the group from the measure.
              Control1..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Extension Definition for MeasureReport.group.linkId for Version 5.0) (Extension Type: string)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              66. MeasureReport.group.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              68. MeasureReport.group.code
              Definition

              The meaning of the population group as defined in the measure definition.

              ShortMeaning of the group
              Control0..1
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              70. MeasureReport.group.population
              Definition

              The populations that make up the population group, one for each type of population appropriate for the measure.

              ShortThe populations in the group
              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. MeasureReport.group.population.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              74. MeasureReport.group.population.extension
              Definition

              An Extension

              ShortExtension
              Control1..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on MeasureReport.group.population.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 76. MeasureReport.group.population.extension:linkId
                Slice NamelinkId
                Definition

                Optional Extension Element - found in all resources.

                ShortUnique id for group.population from the measure.
                Control1..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Extension Definition for MeasureReport.group.population.linkId for Version 5.0) (Extension Type: string)
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                78. MeasureReport.group.population.extension:description
                Slice Namedescription
                Definition

                A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                ShortDescription of the population
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Measure Report Population Description) (Extension Type: markdown)
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                80. MeasureReport.group.population.extension:supportingEvidence
                Slice NamesupportingEvidence
                Definition

                Specifies the result of a supporting evidence expression in the measure population. The result of the expression is represented in an extension, using the same mapping as specified in Using CQL With FHIR, with the exception that tuples and lists are represented in extensions, rather than mapped to the Parameters resource.

                ShortSpecifies the result of a supporting evidence expression in the measure population.
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension(Supporting Evidence) (Complex Extension)
                Is Modifierfalse
                Must Supporttrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                82. MeasureReport.group.population.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                84. MeasureReport.group.population.code
                Definition

                The type of the population.

                Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationType
                (extensible to http://hl7.org/fhir/ValueSet/measure-population|4.0.1)

                The type of population (e.g. initial, numerator, denominator, etc.).

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                86. MeasureReport.group.population.count
                Definition

                The number of members of the population.

                ShortSize of the population
                Control0..1
                Typeinteger
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                88. MeasureReport.group.population.subjectResults
                Definition

                This element refers to a List of subject level MeasureReport resources, one for each subject in this population.

                ShortFor subject-list reports, the subject results in this population
                Control0..1
                TypeReference(List)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                90. MeasureReport.group.measureScore
                Definition

                The measure score for this population group, calculated as appropriate for the measure type and scoring method, and based on the contents of the populations defined in the group.

                ShortWhat score this group achieved
                Control0..0
                TypeQuantity
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                92. MeasureReport.group.stratifier
                Definition

                When a measure includes multiple stratifiers, there will be a stratifier group for each stratifier defined by the measure.

                ShortStratification results
                Control0..0
                TypeBackboneElement
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                117. MeasureReport.evaluatedResource
                Definition

                A reference to a Bundle containing the Resources that were used in the calculation of this measure.

                ShortWhat data was used to calculate the measure score
                Control0..*
                TypeReference(Resource)
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))